SECTION 1. The legislature finds that the
nature of the maternity and prenatal services provided by midwives could
potentially endanger the health and safety of women and newborns under a
midwife's care if the profession is not adequately regulated. Public health
and safety concerns substantially outweigh any negative effects arising from
regulation, including the resulting restrictions on individuals entering the
profession of midwifery and any increase in the cost of midwifery services
caused by regulation of the profession. The legislature further finds that the
auditor, in its sunrise analysis on the regulation of certified professional
midwives, applied the criteria for licensure in the Hawaii regulatory licensing
reform act. The auditor recommended that the profession of midwifery be
regulated and its practitioners be licensed.

The purpose of this Act is to establish
mandatory licensing for persons who engage in the practice of midwifery care.

SECTION 2. The Hawaii Revised Statutes is
amended by adding a new chapter to be appropriately designated and to read as
follows:

"Chapter

midwives

§ -1 Definitions. As
used in this chapter:

"Accreditation Commission for Midwifery
Education" means the organization established in 1982 and recognized by
the United States Department of Education as an accrediting agency for
midwifery education programs.

"Board" means the state board of
nursing established under section 457-3.

"Client" means a person under the
care of a licensed midwife, as well as the person's fetus and newborn child.

"Licensed midwife" means an
individual who holds a current license issued by the board pursuant to this
chapter to engage in the practice of midwifery in Hawaii.

"Midwife" means a person who engages
in the practice of midwifery.

"Midwifery Education Accreditation
Council" means the organization established in 1991 and recognized by the
United States Department of Education as an accrediting agency for midwifery
education programs and institutions.

"Out-of-hospital" means taking place
in a birth center or home.

"Postpartum period" means the period
not exceeding six weeks from the date of delivery.

"Practice of midwifery" means
providing well-woman and maternity care for individuals and their newborns
during the antepartum, intrapartum, and postpartum periods.

§ -2 Powers and
duties. In addition to any other powers and duties authorized by law, the board
shall:

(9) Subject to chapter 91, adopt, amend, or repeal
rules, as necessary to effectuate this chapter.

§ -3 Advisory
committee; appointment; term. (a)The board shall appoint an
advisory committee to serve as experts to the board in licensing matters. The
advisory committee shall consist of seven members as follows:

(1) The chair of the board, or the chair's designee,
who shall be a nonvoting member;

(2) Four licensed midwives who shall be in current
and active practice of midwifery in the State for the duration of their
appointment and who shall have actively practiced as licensed midwives in the
State for at least three years immediately preceding their appointment, who
shall be voting members; provided that the four midwives initially appointed
under this paragraph shall be as follows:

(A) Two certified professional midwives who
shall be in current and active practice of midwifery in the State for the
duration of their appointment and who shall have actively practiced as
certified professional midwives in the State for at least three years
immediately preceding their appointment, who shall be voting members; and

(B) Two certified nurse midwives who shall be
in current and active practice of midwifery in the State for the duration of
their appointment and who shall have actively practiced as certified nurse
midwives in the State for at least three years immediately preceding their
appointment, who shall be voting members;

(3) One licensed physician who has provided primary
maternity care for at least twenty births in the twelve-month period prior to
appointment, maintains current hospital privileges, and has attended at least
one home birth, who shall be a nonvoting member; and

(4) One out-of-hospital birth consumer who is either
currently under midwifery care and planning an out-of-hospital birth or has had
an out-of-hospital birth in the past, who shall be a nonvoting member.

(b) Members of the committee shall serve four-year
terms; provided that the initial members of the committee shall serve two-year
terms; provided further that after June 30, 2017, members of the temporary
advisory committee appointed under section 3 of Act , Session Laws of Hawaii
2017, may continue in office as holdover members until their successors are
appointed.

(c) In the event of the death, resignation, or
removal of any committee member before the expiration of the member's term, the
vacancy shall be filled for the unexpired portion of the term in the same
manner as the original appointment.

(d) The committee shall elect a chairperson
from among its members. The committee shall meet at least annually to make
recommendations to the board and may hold additional meetings at the call of
the chairperson or at the written request of any two members of the committee.
Three voting members shall constitute a quorum. The vote of the majority of
members present at a meeting in which a quorum is present shall determine the
action of the committee.

§ -4 Scope of
practice; formulary. (a) The board shall establish scope of practice
standards for the practice of midwifery.

(b) The scope of practice standards shall
include:

(1) Adoption of a drug formulary recommended by the
advisory committee and approved by the board; and

(2) Practice standards for antepartum, intrapartum,
postpartum, and newborn care that prohibit a licensed midwife from providing
care for a client with a history of disorders, diagnoses, conditions, or
symptoms outside of the scope of practice approved by the board.

(c) The scope of practice standards shall not:

(1) Require a licensed midwife to practice under the
supervision of another health care provider, except as a condition imposed as a
result of discipline by the board;

(2) Require a licensed midwife to enter into an
agreement with another health care provider, except as a condition imposed as a
result of discipline by the board;

(3) Impose distance or time restrictions on where a
licensed midwife may practice;

(4) Grant a licensed midwife prescriptive privileges
outside of the privilege of ordering, obtaining, and administering medications
on the approved formulary; or

(5) Allow a licensed midwife to perform abortions.

§ -5 License;
qualifications. (a) No person shall engage in the practice of midwifery
in this State unless the person holds a currentlicense issued by the board
pursuant to this chapter. A license shall be granted to an applicant who files
a board-approved application for licensure, pays the required application fees,
and provides evidence to the board of the following:

(1) Completion of an educational program or pathway
accredited by the Midwifery Education Accreditation Council or the Accreditation
Commission for Midwifery Education;

(2) Documentation of a graduate letter from a school
accredited by the Midwifery Education Accreditation Council or the
Accreditation Commission for Midwifery Education or a letter of completion of
portfolio evaluation process; and

(3) Successful completion of continuing education
requirements.

(b) All licenses issued under this chapter
shall be valid for two years from the date of issuance.

§ -6 Fees;
penalties. (a) Each applicant shall pay a licensing fee of $250 upon
application for a new or renewal license. Fees collected pursuant to this
section shall be deposited into the compliance resolution fund established
pursuant to section 26-9(o).

(b) Any fine imposed by the board after a
hearing conducted pursuant to this chapter shall be no less than $100 and no
more than $1,000 for the first violation. A second or subsequent violation of
this chapter shall be referred to the office of the attorney general for
criminal prosecution. Any person who pleads guilty to or is found guilty of a
second or subsequent violation of this chapter shall be guilty of a
misdemeanor.

§ -7 Hearings.
(a) Unless otherwise provided by law, in every case in which the board refuses
to issue, renew, restore, or reinstate a license under this chapter, or
proposes to take disciplinary action or other licensing sanctions against a
licensee, the board shall conduct an administrative proceeding in accordance
with chapter 91.

(b) In all proceedings before it, the board
shall have the same powers respecting administering oaths, compelling the
attendance of witnesses and the production of documentary evidence, and
examining witnesses as are possessed by circuit courts. In case of
disobedience by any person of any order of the board, or of any subpoena issued
by the board, or the refusal of any witness to testify to any matter regarding
which the witness may be questioned lawfully, any circuit judge, on application
by the board, shall compel obedience as in the case of disobedience of the
requirements of a subpoena issued by a circuit court, or a refusal to testify
therein.

§ -8 Exemptions. This
chapter shall not apply to the following:

(1) Student midwives in training under the direct
supervision of licensed midwives;

(2) A person administering care to a spouse or
parent;

(3) A person rendering aid in an emergency where no
fee for the service is contemplated, charged, or received; and

(4) A person performing a service within the person's
authorized scope of practice of a profession that is licensed, certified, or
registered under other laws of this State.

§ -9 Client
protection. A licensed midwife shall not:

(1) Disregard a client's dignity or right to privacy
as to the client's person, condition, possessions, or medical record;

(2) Breach any legal requirement of confidentiality
with respect to a client, unless ordered by a court of law;

(3) Submit a birth certificate known by the licensed
midwife to be false or fraudulent, or willfully make or file false or incomplete
reports or records in the practice of midwifery;

(5) Engage in the practice of midwifery while
impaired because of the use of alcoholic beverages or drugs; or

(6) Violate any other standards of conduct as
determined by the board.

§ -10 Disclosure;
record keeping. (a) Before initiating care, a licensed midwife shall
obtain a signed informed consent agreement from each client.

(b) All licensed midwives shall maintain a
record of signed informed consent agreements for each client pursuant to
section 622-58.

§ -11 Immunity from
vicarious liability. No licensed medical provider or facility providing
medical care or treatment to a person due to an emergency arising during childbirth
as a consequence of care received by a licensed midwife shall be held liable
for any civil damages as a result of such medical care or treatment unless the
damages result from the licensed medical provider or facility's provision of or
failure to provide medical care or treatment under circumstances demonstrating
a reckless disregard for the consequences so as to affect the life or health of
another. A physician who consults with a licensed midwife but who does not
examine or treat a client of the midwife shall not be deemed to have created a
physician-patient relationship with the client."

SECTION 3. (a) There shall be established a
temporary advisory committee to serve as experts to the board in midwife licensing
matters. The temporary advisory committee shall consist of seven members as
follows:

(1) The chair of the board, or the chair's designee,
who shall be a nonvoting member;

(2) Two certified professional midwives who shall be
in current and active practice of midwifery in the State for the duration of
their appointment and who shall have actively practiced as certified
professional midwives in the State for at least three years immediately
preceding their appointment, who shall be voting members;

(3) Two certified nurse midwives who shall be in
current and active practice of midwifery in the State for the duration of their
appointment and who shall have actively practiced as certified nurse midwives
in the State for at least three years immediately preceding their appointment,
who shall be voting members;

(4) One licensed physician who has provided primary
maternity care for at least twenty births in the twelve-month period prior to
appointment, maintains current hospital privileges, and has attended at least one
home birth, who shall be a nonvoting member; and

(5) One out-of-hospital birth consumer who is either
currently under midwifery care and planning an out-of-hospital birth or has had
an out-of-hospital birth in the past, who shall be a nonvoting member.

(b) In the event of the death, resignation, or
removal of any temporary advisory committee member before the expiration of the
member's term, the vacancy shall be filled for the unexpired portion of the
term in the same manner as the original appointment.

(c) The temporary advisory committee shall
elect a chairperson from among its members. The committee shall meet at least
annually to make recommendations to the board and may hold additional meetings
at the call of the chairperson or at the written request of any two members of
the committee. Three voting members shall constitute a quorum. The vote of
the majority of members present at a meeting in which a quorum is present shall
determine the action of the committee.

(d) The temporary advisory committee shall
submit annual reports to the legislature not later than twenty days prior to
the convening of the regular sessions of 2018 and 2019.

(e) The temporary advisory committee shall
cease to exist on June 30, 2019; provided that all members shall continue to
serve as the initial members of the permanent advisory committee established
under section -3 in section 2 of the Act until their successors are
appointed.

SECTION 4. If any provision of this Act, or
the application thereof to any person or circumstance, is held invalid, the
invalidity does not affect other provisions or applications of this Act that
can be given effect without the invalid provision or application, and to this
end the provisions of this Act are severable.

SECTION 5. This Act does not affect rights and
duties that matured, penalties that were incurred, and proceedings that were
begun before its effective date.

SECTION 6. This
Act shall take effect on July 1, 2019; provided that section 3 shall take
effect on July 1, 2017.